When assessing a child after heart surgery to correct Tetralogy of Fallot (TOP) which finding should alert the nurse to suspect a le carat output?
Altered level of consciousness and treaty pulse
Bounding pulses and mottled skin
Capillary refill of 2 seconds and blood pressure of 96/47 mmHg
Extremities warm to the touch and pale skin
The Correct Answer is A
A.Altered level of consciousness and thready pulse.
In a child after heart surgery to correct Tetralogy of Fallot (TOF), a thready pulse and altered level of consciousness can be indicative of poor cardiac output. This may suggest that the heart is not effectively pumping blood to meet the body's needs.
B. Bounding pulses and mottled skin: Bounding pulses and mottled skin are not typical signs of decreased cardiac output. Bounding pulses are often associated with increased cardiac output.
C. Capillary refill of 2 seconds and blood pressure of 96/47 mmHg: A capillary refill of 2 seconds is within the normal range, and a blood pressure of 96/47 mmHg is reasonable for a child. These findings do not necessarily indicate poor cardiac output.
D. Extremities warm to the touch and pale skin: Warm extremities and pale skin are not typical signs of decreased cardiac output. Cold extremities and cyanosis may be more concerning signs.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Continuing to offer a special formula to limit gagging is not a standard approach in the care of infants with cerebral palsy. The choice of formula should be based on the child's nutritional needs, and any feeding difficulties should be addressed by a healthcare professional.
B. Maintaining immobility of the limbs with splints is not recommended. Encouraging movement and mobility is important for the development and well-being of children with cerebral palsy.
C. Preserve muscle tone to prevent joint contractures.
Cerebral palsy is a condition that can lead to problems with muscle tone and movement. Preserving muscle tone is important to prevent joint contractures, which can limit mobility and cause pain. Physical therapy and exercises can help maintain muscle tone and joint flexibility in children with cerebral palsy.
D. Focusing on cognitive rather than motor skills is not appropriate. Motor skills are a crucial aspect of development for children with cerebral palsy. The approach should encompass both cognitive and motor skill development as appropriate for the child's age and abilities.
Correct Answer is D
Explanation
A. You seem overwhelmed, I'll contact the chaplain to come and talk with you about the options: While offering chaplain support is valuable, it's essential to engage in a conversation with the parents first to understand their needs and concerns.
B. I find it helpful to investigate the options. I will get you a pamphlet about end-of-life care: Providing information is valuable, but in this case, the parents are expressing their emotional distress, and they may need a more empathetic and personalized approach.
C. It's hard to say what the best decision is, but I know the end-of-life team provides wonderful care: While reassuring, this response doesn't actively engage with the parents or explore their feelings and beliefs, which are crucial for making this challenging decision.
D. These decisions are challenging. Tell me about your beliefs and understanding about end-of-life.
This response acknowledges the parents' difficulty with the decision and opens the door for a deeper conversation. It allows the nurse to understand the parents' perspectives, values, and concerns, which is crucial in providing holistic and patient-centered care. This information will help the nurse support the family and guide them through the decision-making process, addressing their specific needs and preferences.
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